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A patient-centered medical home builds trust between patient and doctor, improving prevention and healthcare

In my last post, I discussed the promise of a patient-centered medical home, and how smarter healthcare will benefit us all by improving the trust relationship between doctors and patients. In turn, how do you create and enable a patient-centered medical home?

First and foremost, from IBM’s point of view, patient-centered medical home (PCMH) is an effort to address the high cost/low value situation we find ourselves in as large employer buyers of care.

Study after countless study shows that when a patient has a primary care physician who cares about them, and that physician has (and uses) the tools to practice comprehensive patient-centric care, they get the care they need at a price we can afford.

But we the buyers have been part of the problem (as Pogo said so long ago, “We have met the enemy and he is us") in not demanding systems of payment and practice organization that encourage and enable the comprehensive, patient-focused primary care we desire.

There is no money paid for the necessary investments in teams and health information systems so essential to the delivery of comprehensive, cost-effective, patient-centered care. Current payment methods richly reward medical procedures and discourage spending time with patients in such essential activities as history taking, physical examination, diagnosis, planning treatment, counseling, coordination and prevention. This must change.

When one compares the U.S. healthcare system with those of other industrialized countries, one is led to the more specific conclusion that the two major problems in U.S. healthcare are the way we:

1. fail to deliver comprehensive primary care (PCMH)
2. the way primary care is financed (Accountability)

Our premise is that someone agreeing to be a comprehensivist, like a primary care doc or an infectious disease doc caring comprehensively for their patient, is the only natural locus of control of healthcare quality and costs.

This needs to be funded and financed in an accountable way. Accountable care organizations (ACOs) are the way to do that. PLEASE PLEASE do not try to separate how the money flows (AC) from the principles all primary care has agreed on (PCMH). If you make that separation, we are in real trouble.

A primary care physician is the only entity charged with longitudinal care, considering the whole patient, the health of the whole person, including mental and physical.

As large employers, our national focus on disease management programs is a good example of the failure of primary care. This focus epitomizes the failure of our efforts to improve care by relying on a work around that does not address the real issue head on.

If stand-alone disease management programs are considered necessary today, it is because primary care is not doing its job. From a primary care/comprehensivist perspective, the treatment of chronic conditions (such as diabetes, congestive heart failure and asthma) with the right tools is basic and straightforward.

The care of these conditions is simply not that difficult. However, the quality failures in the treatment of these conditions are well documented. Stand-alone disease management programs that are not delivered at the point of care present a Band-Aid approach to problem solving.

Instead of directly addressing problems, these kinds of work arounds have, in fact, created additional, expensive, fragmented responses to the primary problem.

For some reason, the healthcare industry and we as the buyer have demonstrated an inability to develop a sharp focus on solving core problems. We seem much more willing to create complicated responses to our problems than we are to fix the core problems of our delivery system.

Again, disease management is a perfect example. If primary care is not delivering high quality care for those with chronic conditions, we can either find a way to work around primary care or we can find a way to fix it.

Rather than being willing to pay for prevention and primary care, we’re willing, as large employers, to "pay any price” for episodic care (which, for example, provides for a diabetic amputation of a limb). We are unwilling to open our eyes and understand that the reason for the amputation was our failure to pay for prevention.

Next week, I’ll talk about how we can redesign healthcare.

Join Dr. Grundy at the Central & North Florida HIMSS conference this week, on Friday, Jan 21 at 8:15 AM, to hear him speak on the Patient-Centered Medical Home.

For more information, visit the Patient-Centered Primary Care Collaborative.